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 Primary Endpoints:

Time to awakening post OHCA, cerebral p
Time to awakening post OHCA, cerebral performance category (CPC),survival to discharge (SDC)Secondary Endpoints:periarrest and post CA careResultsA total of 47 OHCA pts ,15received HT, with 7 (46.6%) SDC. Of the 32 pts who received conventional ca

re (no hypothermia), 13 (40.6%) SDC. Amo
re (no hypothermia), 13 (40.6%) SDC. Among survivors, those receiving hypothermia as compared to conventional care, were more likely to have a witnessed arrest, 86% vs69%; bystander CPR, 43% vs8%; and ventricular fibrillation as their initial rhythm, 57%

vs46%. In those treated with convention
vs46%. In those treated with conventional care, 38.5% were alert shortly following resuscitation, and 80% of these patients had a CPC score of 1 or 2 on day 3. The figure presented here depicts the time course of change in CPC score in patients receivin

g HT withPrimary Outcome: Of the 15 OH
g HT withPrimary Outcome: Of the 15 OHCA pts with HT, 7 (46.6%) SDC with 83% discharged with a CPC of 1 or 2Conclusion:Contrary to the established paradigm, patients with hypothermia achieve substantial neurological awakening that may start at day 3

but is not apparent until day 7 and poss
but is not apparent until day 7 and possibly longer. Implications: The timing of decision making for care withdrawal in such critical patients should be validated in larger cohorts.A Paradigm Redefined: Time Course of Neurological Recovery Following Hy

pothermia Therapy Post Non-traumatic OHC
pothermia Therapy Post Non-traumatic OHCAShaker Eid, MD, American Heart Association ReSS © 2010, American Heart Association. All rights reserved.BACKGROUND:For more than 25 years,

the prognosis for recovery post cardiac
the prognosis for recovery post cardiac arrest and the decision making for withdrawal of care has been based on the neurological exam at 72 hours. Whether this paradigm also applies to patients {pts} receiving hypothermia therapy (HT) post-arrest has not

been thoroughly investigated.PURPOSE:
been thoroughly investigated.PURPOSE: To determine the time course of neurological recovery following HT post Out-of-Hospital Cardiac Arrest (OHCA).
\nPrimary Endpoint: Time to awakening for OHCA TH pts.Secondary Endpoints: 1) Time from

911 to ALS care; 2)Time pt treated with
911 to ALS care; 2)Time pt treated with TH); 3) time re-warming to awakening measured with use of Cerebral Performance Category (CPC) scoreResults: A total of 66 pts (mean age 59.5 +5.6 years, 62% male) were included. The time from 911 to start of

advanced life support care was 9.1 +8
advanced life support care was 9.1 +8.0 minutes. Time to awakening is shown in the figure. All six pts with delayed awakening (� 72 hours) had good neurological function based upon a CPC score of 2 within 30 days of OHCA. Five of 6 of these

pts were intubated, comatose, and apneic
pts were intubated, comatose, and apneic 72 hours after re-warming.Primary Outcome: Of the 66 OHCA TH pts; 6 awakened 72 hrs beyond OHCA.Conclusion:Withdrawal of life support 72 hrs after arrest including re-warming may prematurely terminate life in

at least 10% of potentially neurologica
at least 10% of potentially neurologically intact TH survivors.Implications: The time clinicians should wait before withdrawing supportive care for comatose pts after TH may need to be extended beyond 72 hrs.Awakening After Cardiac Arrest and Post-Res

uscitation Hypothermia: Are We Pulling t
uscitation Hypothermia: Are We Pulling the Plug too Early?Keith Lurie, MD, American Heart Association ReSS ©. 2010, American Heart Association. All rights reserved.BACKGROUND:For more than 25 years

, the prognosis for recovery post cardia
, the prognosis for recovery post cardiac arrest and the decision making for withdrawal of care has been based on the neurological exam at 72 hours. Time to awakening after out-of-hospital cardiac arrest (OHCA) and post-resuscitation therapeutic hypother

mia (TH) varies widely. The amount of ti
mia (TH) varies widely. The amount of time clinicians should wait before withdrawing supportive care for comatose pts after TH is unknown. PURPOSE: To determine the time interval from when OHCA TH pts had been fully re-warmed to 37C to when they showed

definitive signs of awakening311010152
definitive signs of awakening311010152025303512243648728496108120132144156168180192204216228240252Number of PatientsTime Following Re-warming (Hours)Time to Awakening Following Out-of Hospital Cardiac Arrest Treated with Therapeutic Hypothermia(N=66 Pa

tients) Time 0 = Time Re-warming was Com
tients) Time 0 = Time Re-warming was Complete

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